President of the Indian Society for Paediatric Dermatology, Professor & Head of Department. of Paediatric Dermatology at the Institute of Child Health at Kolkata, India
Dr. Sandipan Dhar is a renowned Paediatrc Dermatologist & Atopic Dermatitis (AD) researcher. He has published 220 scientific papers, written 6 books, 25 chapters in various books, delivered 300 national lectures & 30 international lectures. He had been Chair and speaker in WCD, Vancouver, 2015 on AD symposium, Chair and moderator in AD session in WCPD, Chicago, 2017. He is the guest speaker on AD in Pediatric Dermatology session of WCD, Milan, June 2019.
Short Description of the Lectures:
- Fever with Skin Rash in Paediatric Age Group: How to Approach for Diagnosis
Fever itch skin eruptions can be because of several etiologies, measles, rubella, varicella, dengue fever, staphylococcal scalded skin syndrome, Typhoid fever, infectious mononucleosis, TORCH infection Kawasaki disease, toxic shock syndrome, chikungunya fever, hand-foot & mouth disease, Rickettsial diseases and a host of other infections. Various collagen vascular diseases e.g., SLE, Dermatomyositis, vasculitis and various adverse drug reactions can manifest as fever with skin rash. Of late some entities have been found to be major causes of fever with skin rash in infants and children in India & subcontinent as well as various parts of the Globe. They are dengue fever, rickettsial diseases, hand-foot and mouth disease, chikungunya fever is to name a few. Awareness and high degree of suspicion only can pick up such cases at the earliest. Early diagnosis is very important from therapeutic point of view.
- Adverse Cutaneous Drug Eruptions in Infants & Children
Various adverse cutaneous drug reactions in pediatric age group can be classified as:
- Nonimmune cutaneous reactions: photosensitivity eruptions pigmentation changes, warfarin necrosis of skin, pruritus etc.
- Immune-mediated cutaneous reactions: It can be either
(i)milder or benign: maculopapular eruptions, Urticarial rash, angioedema, fixed drug eruptions. Or (ii)severe rash: Vasculitis, acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN).
Drugs reactions can also be divided considering dose relatedness, timing, and patient susceptibility (DoTS). Dose relatedness points to the doses above, below, or the common therapeutic range (toxic, hypersusceptibility, and collateral adverse reactions). The significance of time relatedness considers time between first use and the appearance of the adverse reaction and hence are – immediate, first dose, early, intermediate, late, and delayed. The role of susceptibility factors consider several factors that enhance the susceptibility to the adverse reaction like – genetic, age, gender, physiological changes, exogenous drugs, and diseases. Early diagnosis and aggressive management are the cornerstone of success in handling such cases. Identifying the offending drug is the key to success.
- Langerhans Cell Histiocytosis: Challenges in Diagnosis & Management
Langerhans cell histiocytosis(LCH) encompasses three related clinical entities of unknown etiology, characterized by histiocytic proliferation known as Letterer-Siwe disease, Hand-Schüller-Christian disease and eosinophilic granulmoma. It is an underdiagnosed condition.
Therapeutic regimens for histocytosis-X vary widely. Blood transfusions and antibiotics improve the long-term outlook for such patients. Immunosuppressive drugs in proper combination may give long-term remissions. Prednisolone at a dose of 2-4 mg/kg/day may result in complete clearing of lesions or long-term remissions for 1-2.5 years. Alkylating agents viz., nitrogen mustard, chlorambucil and cyclophosphanide appear to be highly effective. Methotrexate, either alone or in combination with oral corticosteroids, is also an effective modality of treatment. In general, patients with Hand-Schuller-Christian disease and eosinophilic granuloma responds better to therapy than patients with Letterer-Siwe disease. Radiotherapy is effective for localized skeletal lesions. The overall prognosis of LCH is good.